How is HIV Spread?

People infected with HIV carry the virus in their body fluids, including blood, semen, vaginal secretions, and breast milk. The virus can spread only if these HIV-infected fluids enter the bloodstream of another person. This can take place (1) through the linings of the vagina, rectum, mouth, or the opening at the tip of the penis; (2) through injection with a syringe; or (3) through a break in the skin, such as a cut or sore. The most common ways that people become infected with HIV are:

Unprotected sexual intercourse (either vaginal or anal) with someone who has HIV. The majority of HIV-positive young adults in the U.S. become infected this way.

Sharing needles or syringes (including those used for steroids) with someone who has HIV.

Mother-to-child transmission during pregnancy, childbirth, or breast-feeding. This has declined steeply in the U.S. since the 1990s due to medications that protect infants from infection.

Are You Afraid You May Already Have HIV?

Some people develop mild, temporary flu-like symptoms or persistent swollen glands immediately after becoming infected with HIV. But symptoms are not a good indicator of HIV infection, because many people don’t experience any symptoms for many years. Even if you look and feel healthy, you could still be infected.

You may be at risk if you have had unprotected sex or if the condom broke during sex, if you have multiple partners or have discovered your partner was not monogamous, if you have shared needles, if you recently tested positive for another sexually transmitted infection, or if you were sexually assaulted. And it is important to know that HIV is more easily passed from men to women or from the insertive partner to the receptive partner among men who have sex with men.

If you think there’s a chance you may have been exposed to HIV, you should get tested as soon as possible.

What Happens When You Get Tested?

Photo by Wheeler CowperthwaiteThere are several types of HIV test. The most common are the antibody test and the antigen-antibody test. Both of these take up to one week to generate results and should be followed up with additional testing. Antibody tests can generate false positives and should always be followed by an antigen test to confirm a positive result. If doubts persist, doctors usually recommend a third very sensitive and expensive test that can detect the presence of the virus itself.

In addition to the blood tests described above, another option is the OraSure rapid test, which uses a swab of oral mucus or fluid from the inside of your cheek. Rapid tests can detect HIV antibodies in about 20 minutes, eliminating the waiting period between taking an HIV test and learning your status.

Bear in mind—newer antigen-antibody lab tests cannot detect HIV until two to three weeks after exposure to the virus, and it can take three months after the last possible exposure to HIV before a person will test positive with a blood or oral antibody test. Because of this window period, a negative test result does not necessarily rule out HIV infection. Since the virus is most infectious in the earliest weeks after HIV infection, you should take great care to avoid unprotected sex if you think you may have been exposed to HIV. If you have engaged in high-risk sexual activity, it is important to be re-tested every three months.

A positive HIV test result indicates that antibodies to HIV or HIV antigens were detected. It does not mean that you have AIDS or that you will get sick right away. And although there is no cure for HIV/AIDS, currently available drugs are highly effective at keeping the virus in check.

Where Can You Go to Get Tested?

Many young people who are HIV positive don’t know it, which means they can’t take important steps to protect themselves or other people, or to get the medical care they need. In 2013, only 13% of all high school students—and 22% of those who had ever had sexual intercourse—had been tested for HIV. And in 2013, only 33% of adults aged 18–24 had ever received a test. As a result, an estimated 51% of those under 25 living with HIV are unaware of their infection.

It's ideal to get tested at a place that provides counseling because counselors can help you understand what your test results mean, answer questions about how to protect yourself and others, and refer you to local HIV-related resources.
You can get tested for HIV by your doctor, at local health department clinics, or at hospitals. In addition, many states offer anonymous HIV testing.

It is also possible buy an OraSure rapid oral HIV test over the counter at most pharmacies and test yourself. If you do test positive, you should see your doctor and get a blood test to ensure the result is accurate. To find an HIV testing site near you, visit https://gettested.cdc.gov/ or call the Centers for Disease Control and Prevention’s 24-hour toll-free hotline at 800-CDC-INFO (800-232-4636).

Why Is It Important to Know if You’ve Got HIV?

If you think you may have HIV, it is important to find out as soon as possible. HIV is most easily transmitted when the level of virus in the body is at its highest—shortly after HIV infection and at the late stages of the disease. Even in the early stages of HIV infection, you can take concrete steps to protect your long-term health. Beginning medical care before you begin to get sick may give you many more years of healthy life. And knowing you’re HIV positive allows you to take the necessary precautions to prevent others from becoming infected.

If you are HIV positive, it is important to see your doctor regularly. Get tested for tuberculosis and other opportunistic infections. Keep your immune system strong through good nutrition, adequate sleep, and not smoking or drinking alcohol. And find a support system—it is important to remember that you are not alone.

How Can You Tell if Someone Has HIV/AIDS?

You can’t tell if someone has HIV or AIDS simply by looking. An infected person can appear completely healthy. But anyone infected with HIV can infect other people, even if no symptoms are present and even if they believe they are negative. If you are sexually active, the only way to be sure you don’t have HIV is to get tested.

If you’re not sexually active, you’ve already eliminated the most common cause of HIV infection among teens. But if you have made the decision to have sexual intercourse, you need to protect yourself.

HIV/AIDS doesn’t discriminate. That means that anyone who engages in risky behavior can become infected with HIV. But the epidemic has taken an especially heavy toll on some groups of young people, especially African-American and Latino youth, young women, and young men who have sex with men (whether or not they think of themselves as gay).

In 2010, African Americans represented 17% of teenagers and 16% of people aged 20–24 in the overall population, but accounted for 57% of new HIV infections among those aged 13–24. Young men who have sex with men (MSM), especially those of color, have the highest risk of HIV infection among young people. Among youth aged 13-24 diagnosed with HIV in 2014, 80% were gay and other MSM. Of those, 55% were black, 23% were Hispanic/Latino, and 16% were white. Adolescent females are also at risk. In 2010, women aged 13-24 accounted for 22% of new HIV infections among women of all ages.

When Is Safer Sex Important?

The rules are simple. Whenever you have sexual intercourse (or oral sex), practice safer sex by using a condom or dental dam (a square of latex recommended for use during oral sex). When used properly and consistently, condoms are close to 99% effective in preventing transmission of HIV. But remember:

Use only latex condoms (or dental dams);

Use only water-based lubricants;

Use protection each and every time you have sex.

Other methods of birth control (such as the diaphragm and birth control pills) do not protect against HIV and other sexually transmitted infections (STIs). Practicing safer sex will help you avoid other STIs, many of which can increase your risk of contracting HIV or giving it to someone else. You should also limit the number of sexual partners you have, and limit the use of alcohol or recreational drugs, which can impair judgment during sex.

Is Protection Necessary During Oral Sex?

While it’s much easier to contract HIV through unprotected vaginal or anal sex, unprotected oral sex is not a completely safe substitute. If you choose to perform or receive oral sex—whether your partner is male or female—it's wise to guard against the transmission of HIV. Here’s how:

Use a latex condom each and every time you perform oral-penile sex (fellatio); or
Use plastic food wrap, a latex condom cut open, or a dental dam during oral-vaginal sex (cunnilingus) or oral-anal sex (analingus).

These methods provide a physical barrier to HIV transmission and help keep you safe from other sexually transmitted infections, many of which can increase your risk of contracting HIV or giving it to someone else.

Aren’t HIV and AIDS the Same Thing?

HIV (human immunodeficiency virus) causes AIDS (acquired immunodeficiency syndrome). When HIV infects someone, the virus enters the body and begins to multiply and attack immune cells that normally protect us from disease. Eventually the body's immune system breaks down and is unable to fight off opportunistic infections and other illnesses ranging from pneumonia and cancer to blindness and dementia. Only when someone with HIV begins to experience these specific infections and illnesses are they diagnosed with AIDS.

Is There a Cure for HIV/AIDS?

AIDS is still a life-threatening disease for which there is no cure and no vaccine. New medications are helping many people with HIV/AIDS live longer, healthier lives, but the combination or “cocktail” treatments don’t work for everyone. They’re very expensive and often cause serious side effects, including liver damage, increased risk of heart attack, a form of osteoporosis, chronic diarrhea, rashes, fat redistribution, and high cholesterol. And because HIV mutates constantly, the virus often develops resistance and the medications become ineffective. The best defense is to use a condom.

Do STIs Make It Easier to Get HIV?

HIV/AIDS isn’t the only sexually transmitted infection young people have to worry about. There’s a virtual alphabet soup of STIs floating around out there, including chlamydia, genital warts, gonorrhea, herpes, and syphilis. A 2009 study showed that approximately one in four girls aged 14–19 in the U.S. have had at least one STI.

Having a sexually transmitted infection can increase your risk of acquiring or transmitting HIV and developing AIDS. This is true whether you have open sores or breaks in the skin (as with syphilis, herpes, and chancroid) or not (as with chlamydia and gonorrhea). Where there are breaks in the skin, HIV can enter and exit the body more easily. But even when you have undamaged skin, STIs can cause biological changes that may make HIV transmission more likely. Studies show that people with HIV who are infected with another STI are two to five times more likely to contract or transmit the virus through sex. What to do? Practice safer sex.

Can You Get HIV Through Casual Contact?

HIV is not an easy virus to pass from one person to another, like the flu. It is not transmitted through food or air (for instance, by coughing or sneezing). There has never been a case where a person was infected by a household member, relative, co-worker, or friend through casual or everyday contact such as sharing eating utensils and bathroom facilities or hugging and kissing. (Most scientists agree that while HIV transmission through deep or prolonged “French” kissing might be possible, it’s extremely unlikely.) There have been no recorded cases of transmission through contact with saliva, tears, or sweat.

Mosquitoes, fleas, and other insects do not transmit HIV; when they bite a person, they inject their own saliva, not their blood or the blood of the last person they bit. In the U.S., thorough screening of the blood supply for HIV since 1985 has virtually eliminated the risk of infection through blood transfusions. And you can’t get HIV from giving blood at a blood bank or other established blood collection center; they use sterile-packed needles every time they draw blood.